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Financial Assistance For Medicare Beneficiaries

I thought it might be helpful to review the programs that exist to help low income elders with their Medicare premiums and co-pays. These programs aren't well known, and many people who are eligible never apply. Maybe there will be something here that will help you or your elder:

The "Qualified Medicare Beneficiary" Program (QMB)

QMB will pay the Medicare Part A monthly premium (if applicable - not everyone has to pay this), the Medicare Part B Premium, the Part B annual deductible, and the co-insurance and deductible amounts for services under A and B. To receive co-insurance benefits, your doctor must be certified as a Medicaid provider and accept QMB. Many physicians will accept QMB even if they don't regularly accept Medicaid patients, so check.

QMB will not pay Medigap premiums, but if the individual has QMB, you may not need a Medigap policy.

Eligibility: The individual must be eligible for Medicare Part A (even if not currently enrolled). The individual's monthly income must be at or below 100% of the annual federal poverty level (this changes every year - search "Federal Poverty Leval" for the most current numbers. In most circumstances personal assets, including cash, bank accounts and investments can't exceed $4,000 for an individual and $6,000 for a married couple. The value of the home isn't counted.

Specified Low Income Medicare Beneficiary Program (SLMB)

SLMB will pay the individual's Medicare Part B monthly premium. No other benefits are included. However, benefits could be retroactive up to 3 months prior to the application.
To qualify for SLMB the individual must be eligible for Medicare Part A (even if not enrolled).

The individual's monthly income must be between 100% and 120% of the annual federal poverty level.Personal asset allowances are the same as for QMB above.

How To Apply

You can request an application from your local State Department of Human Services/ Department of Social Services (look in the Blue Government Pages - usually located in the front of the white pages of your telephone book for your local office). Eligibility begins on the first day of the month after the month when your local DHS/DSS has all the information and verification necessary to determine eligibility. This is not supposed to take more than 45 days from the time you send in your completed application.

This all sounds quite confusing, I know. If you think your elder (or you) might be eligible for QMB or SLMB, don't hesitate to call your local office and ask for the application. You're no worse off if you don't qualify, but you might. The QMB program, especially, can save you a bundle of money that your elder doesn't have if he or she qualifies. What do you have to lose?

 

 



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